DESCRIPTION: This application proposes to develop, implement, and evaluate a world wide web-based computerized decision support system (CDSS) to facilitate information exchange and guide interactions between geographically distributed physicians and centrally-located experts in bone marrow transplant (BMT) follow-up care. The CDSS will include standard practice guidelines and research findings specific for the long-term follow-up (LTFU) of patients post-BMT but will be designed to be adaptable to other disease and treatment situations. Key elements required for the conduct of the project are already in place, including an ontology of long-term follow-up, diagnostic pathways, and practice guidelines; a multidisciplinary team with broad experience; a high volume of follow-up and consultation demand; and a network of over 2,000 primary specialists caring for the patients in a wide variety of practice settings. Each year the LTFU unit receives over 5,000 pieces of patient-care mail, sends 4,000 letters, returns 8,000 phone calls, and mails over 1,200 protocols, consent forms, and medical recommendations. The proposed project will complete and refine a networked CDSS, conduct a phase II pilot study of clinical use of the CDSS within the bone marrow transplant center, conduct a phase III randomized clinical trial of the benefit of the CDSS with over 250 primary care physicians randomized to either CDSS or the existing method of follow-up, and evaluate the impact of CDSS on physician behavior and practice efficiency. Endpoints for the phase III portion of the project include patient outcomes and complications, quality of life, cost of patient care, physician satisfaction, and frequency of accessing the protocols/guidelines. An attempt will also be made to identify factors predicting the success of the CDSS.